Healthcare Provider Details

I. General information

NPI: 1659831725
Provider Name (Legal Business Name): JOHNNY JIMENEZ DNP, PMHNP-C, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHNNY JIMENEZ DNP, PMHNP-C, FNP-C

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 MARKET ST STE 1940 PMB 918936
SAN FRANCISCO CA
94105-2448
US

IV. Provider business mailing address

455 MARKET ST STE 1940 PMB 918936
SAN FRANCISCO CA
94105-2448
US

V. Phone/Fax

Practice location:
  • Phone: 559-365-6161
  • Fax: 559-238-0069
Mailing address:
  • Phone: 559-365-6161
  • Fax: 559-238-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95011333
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95011333
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95039845
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: